Menopause

Menopause affects all women, and is the medical name for when monthly periods have stopped for good and it is no longer possible to get pregnant.

An estimated 1.5 million women in the UK are going through the menopause at any one time and 80 per cent will experience symptoms typically lasting four years. For one in 10 women though, the symptoms can last up to 12 years.

Hot flushes, night sweats, vaginal dryness and mood change are common symptoms during this time. Officially, you are classed as having been through your menopause when your last period was at least 12 months ago.

Causes

The menopause occurs when your ovaries stop releasing eggs; and as a result, the female sex hormones oestrogen and progesterone levels fall, whilst the hormones from the pituitary gland, luteinising hormone (LH) and follicle-stimulating hormone (FSH), increase.

It’s this lowering of hormone levels in the bloodstream that leads to menopausal symptoms and disruption of the menstrual cycle. This stage, where periods become less regular and even heavier at times, is called the ‘perimenopause’.

Eventually, periods will stop altogether because oestrogen falls too low for eggs to mature and progesterone levels become too low to stimulate the lining of the womb.

Symptoms

Hot flushes are the most common menopausal symptom, with three out of every four women suffering from them. During a hot flush your face, neck and head will suddenly become hot and this will spread to the rest of your body. Sweating, feeling irritable and having palpitations may also occur.

Other common symptoms include difficulty sleeping, night sweats, vaginal dryness (causing discomfort during sex); mood changes, which can include anxiety, depression, forgetfulness and irritability; reduced sex drive; and recurrent urinary tract infections (UTIs), such as cystitis.

The menopause can also raise your risk of heart disease, which may be due to changes in oestrogen levels; and osteoporosis, a condition that weakens bones. As oestrogen levels fall, women tend to lose bone mass making them more likely to break.

Diagnosis

Your GP may be able to diagnose menopause if you're over 45 by your symptoms. If a woman is younger, the GP may carry out a blood test to measure the FSH hormone to confirm a diagnosis, unless a woman is using combined oestrogen and progesterone contraception. A pelvic examination may also be performed to rule out other possible causes of symptoms.

Who gets the menopause?

The menopause most commonly happens between the ages of 45 and 55 years of age, the average age of which is 51 in the UK.

One in 100 women experience premature menopausal symptoms before 40 years of age. In many cases there’s no clear cause, but some include: smoking; surgery such as a hysterectomy, which removes your womb (uterus); an oophorectomy, which removes both ovaries; and cancer chemotherapy and radiotherapy.

Treatment

Hormone replacement therapy (HRT) is the main treatment available. It eases symptoms, such as hot flushes, night sweats, mood swings and vaginal dryness by restoring levels of oestrogen and progesterone. HRT is available as tablets, skin patches, gel, an implant injected under the skin and as a vaginal cream tablet, ring or pessary.

HRT does have side-effects however, such as breast tenderness, vaginal bleeding, nausea, weight gain, leg cramps, irritability and depression. It’s also linked to an increased risk of breast cancer and blood clots and may not be suitable for women who have a history of these conditions. However, guidance from the National Institute of Health and Care Excellence says oestrogen-only HRT does not increase the risk of breast cancer and whilst combined oestrogen and progesterone HRT does, the risks drop after HRT is stopped.

If HRT isn’t suitable for you, clonidine, a blood pressure drug, and certain selective serotonin reuptake inhibitor (SSRI) antidepressants may be recommended to relieve hot flushes.

For women who suffer with mood changes, cognitive behavioural therapy (CBT), may help. Vaginal moisturisers and lubricants can help with dryness and painful sex problems.

Foods rich in phytoestrogens, including linseed, seeds, pulses and soya foods such as tofu and miso may to beneficial during the menopause as they have a similar chemical structure to oestrogen, and may act as hormone regulators. Evening primrose oil supplements may help with hot flushes while black cohosh may also ease additional menopausal symptoms.

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn’t possible supplements can help. This article isn’t intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.

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